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GED_Transcript_Request

VIEWS: 53 PAGES: 1

									MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION                                                                             GED OFFICE
                                                                                                                               205 JEFFERSON ST
HIGH SCHOOL EQUIVALENCE
                                                                                                                        JEFFERSON CITY, MO 65102
GENERAL EDUCATIONAL DEVELOPMENT (GED) TESTING                                                                                       (573) 751-3504
                                                                                                                                 www.dese.mo.gov


                                                  TRANSCRIPT REQUEST
I have received a Missouri Certificate of High School Equivalence (GED), and need an additional
transcript(s), and/or certificate. My personal information is as follows:
________________________________                                                  ____________________________________
NAME (WHEN TESTED)                                                                SOCIAL SECURITY NUMBER

________________________________                                                  ____________________________________
SIGNATURE                                                                         DATE OF BIRTH

________________________________                                                  ____________________________________
TEST CENTER/CITY WHERE TESTED                                                     APPROX. YEAR WHEN TESTED

                                                                                  ____________________________________
                                                                                  PHONE NUMBER
I AM REQUESTING:

       An OFFICIAL TRANSCRIPT - this document is necessary for admission to post-secondary
       education or employment.
       Complete and mail this form, along with a $2.00 fee, per copy, to the address above.

       A DUPLICATE CERTIFICATE - this may be framed for display, and comes with one
       Official Transcript.
       Complete and mail this form, along with a $15.00 money order payable to “Treasurer, State of
       Missouri”, to the address above.

For faster service send your request and fee through an overnight mail service along with a self-addressed stamped
overnight envelope for the return. We will process it the same day we receive it. Use the address in the upper right-
hand corner of this form for your overnight service.

Please send my __ Official Transcript                            __ Duplicate Certificate to the following:

________________________________________________________________________________
NAME
________________________________________________________________________________
ADDRESS
________________________________________________________________________________
CITY                                                                              STATE                                    ZIP

Please send my __ Official Transcript                            __ Duplicate Certificate to the following:

________________________________________________________________________________
NAME
________________________________________________________________________________
ADDRESS
________________________________________________________________________________
CITY                                                                              STATE                                    ZIP


IF APPLICANT IS UNDER 18 YEARS OF AGE, PARENT MUST SIGN PERMISSION:
________________________________________________________________________________
PARENT SIGNATURE                                                                                       DATE
For your protection, the Privacy Act of 1974 requires written permission signed by you in order to release GED Test results. Records will not be re-
leased by fax or over the telephone. For security and authenticity purposes, official certificates and transcripts are mailed directly from the State GED
Office to the institution, employer, agency or individual. Credential received by any other means, i.e., fax, photocopy, or from an individual, are not
official and may not be valid.
MO 500-1481 (Revised 01-08)

								
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